Vacccine Refusal Forms

Release Form for Vaccine/Lab Telephone Consults pdf

To schedule a consult with Dr. Tenpenny or a healthcare professional at Tenpenny Integrative Medical Center, call 440-239-3438. Business hours are M->F, 9 to 5pEST.

Find a Holistic "vaccine friendly" Healthcare provider pdf

Vaccine Tables

DTaP ingredients
pdf
DTaP death rates pdf
Vaccines with Latex Stoppers pdf
Influenza vaccine ingredients (table)
pdf
Why You Can Get the FLU SHOT and Still Get the FLU pdf
Influenza vaccines, by manufacturer
(a short comparison) pdf
Influenza vs pneumonia; Death stats, 1999-2006 pdf
Charts documenting the decline of infectious disease (large file) pdf

Vaccine Refusal & Exemption Forms

Childcare and School Immunization Requirements This 39 page pdf contains State immunization policies that were validated in August, 2006. Document reflects state laws, regulations, or rules for vaccination requirements for enrollment and/or attendance in day care, Head Start, kindergarten, grades 1 through 12, colleges, and universities. Some maps are included for comparison purposes.

Hep B vaccine in hospital for newborn refusal, sample (pdf)

TB testing refusal, sample (pdf)

OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
Affidavit for Parents with International Adoption (Word) (pdf)

State Immunization Laws Searchable Database This tool contains results from a 50-state legislative review of laws requiring assessment of vaccination status and vaccine administration for healthcare workers and patients/residents. The review was conducted by CDC in 2005 and collected data on laws for the following types of facilities: hospitals, ambulatory care facilities, individual providers' practices, correctional facilities, and facilities for the developmentally disabled.